Question - having significant doubts about my VS assessment skills

[Jedi of Zen]

Hello all,

I am a student, with a question for all the new nurses out there. I have just finished the third semester of a five-semester associate degree program. I feel that by now, my vital-sign assessment skills should be competent, or at least have improved since the days of my first semester clinicals. I pretty much feel okay with getting temps and counting respirations. However, I find that when I try to assess the pulse rate, I can NEVER seem to find a pulse. I usually try the radial pulse first, and no matter how firmly or gently I press, I just can't seem to locate it, ever. Then I try the brachial, and I have the same problem. Usually the only way I'm ever able to get a pulse rate is by using my stethoscope over the apical pulse - and even then I still have problems finding it sometimes. And often it's difficult to distinguish over lung sounds.

Aside from that, I just leave it up the magic of the vital sign machine. However, I would like to be able to think that I can still get a pulse rate without relying on the vital-sign machine if necessary.

So, my question is - did any of you have this (or a similar) problem when you were this far along in school? If so - since you've started working, do you feel that your assessment skills (along with general confidence in yourself) have improved at all? I really don't want to get into doing precepting, graduating, working, etc (all of which I know is virtually right around the corner) and STILL not be able to get a pulse. I feel too scared and stupid to ask my teachers or another student for help.

Any advice/input is welcome. Thank you for your time!

[kelbh]

Do you have access to a Doppler stethoscope? Maybe try that to find the pulse, clean the gel off the area, then try palpating. Also, try listening to the apical pulse and counting that, then palpating at the wrist.

This really DOES get better! It's important for you to be able to palpate pulses, but we all have our sticking points. For one of my new grad friends, it's Foleys. For me, it used to be manual BPS (I know, I know!). I found that when no one was looking over my shoulder, I started getting accurate BPs consistently.

[jjjoy, LPN]

I've found in clinicals, every semester, that my instructor is usually far too busy to be bothered with something that sounds so simple and trivial. Seriously, to ask about something like that would probably be downright offensive to some of the instructors I've had, lol. However, after the fall semester starts, I may try to talk to my new clinical instructor before clinicals even begin and discuss this.

Unfortunately, some instructors aren't very approachable or even very helpful. But luckily you don't need an instructor to practice this type of skill; so if you really think the CI won't be helpful, no need to bring it up with them. You could still ask some classmates if you could help get their patients' vitals or if they could help you find a patient's pulse.

To admit that you haven't "got" this yet might feel embarrassing, but it needn't be. It might seem that it would reflect badly on you, that someone may ask "if she doesn't have this down, what else doesn't she get?" ... but there's really no basis for that kind of doubt. I'll bet you know about a zillion more things than you did a year ago! This is just one little skill that you happen to have a hard time with. Everyone will run across some dumb thing that they just can't seem to get that no one else seems to have trouble with. Know in your heart that it's not indicative of your overall competency. That way, if someone makes an insensitive and unnecessary comment like "oh, goodness! how can you not have gotten this by now?" you can let it roll off your back, knowing that there are many, many other things out there that you have learned so easily that you can't imagine why anyone else would ever have trouble with it!!

Good luck!!!

(FYI this is a little pep talk for myself cuz I can get quite down on myself for not "getting" something that I think I should).

[TenaciousRN]

Jedi,

This is a big problem. I am a first year student, but I believe you should know these skills. You should really talk to your professors and make them help you. It will hurt a lot less now than if you have to take a butt chewing from the other nurses or a doctor because you can't take vitals. The pedal pulse is hard to find, but I had several obese pt's this semester...try starting with light pressure and no matter what they try to tell you it is in a different place on everyone...start almost between the toes and move toward the heel. Once you find it for the first time...it will get better. The hardest time is when the pulse is weak and you have to find a pedal pulse. Close your eyes and block out everything around you.